Health Communication And Social Media

A brief note to mention something really interesting, but still in the works. The last two weeks, I've participated in an online Twitter discussion regarding health care and social media. These conversations tend to be focused on one or two issues, but have started me thinking more about what this medium could provide over time.

I have 2 major questions right now:

1) what do patients want from health care providers on social media? Do they want providers to act as information aggregators, or is the hope that providers will provide direct patient interaction?

2) how can health care providers find good patient-centered resources to follow? I understand that interest and professional groups have accounts, but how many can one follow and really stay on top of things?

I think this is a conversation that is in the early stages and, if to reach maximal benefit, would require major discussions of issues such as online privacy/confidentiality, the HIPAA privacy laws, provider liability, etc.

Not something with any definite answers, but an interesting set of questions.

Next Steps For Health Care

Now that health care reform has been passed and enacted (no longer a bill, but a law), health care will become available for millions who have lacked access until now.

The next big question, then, is where will these patients go? American Medical News published an article indicating that by 2025 the nation will lack nearly 160,000 physicians that will be necessary to provide care for the nation. 46,000 of this anticipated 160,000 physician shortfall are primary care physicians--the very core of a cost-effective and patient-centered health care system. This issue has already developed in Massachusetts, where state law has extended health care coverage to essentially all of the state's residents. The article notes that 40% of family physicians and 60% of internists in the state have stopped accepting new patients, and the wait for a new-patient appointment with a primary care physician is up to 44 days.

Passing health care reform is a tremendous accomplishment. However, it is necessary to take the next steps to truly reap the benefits. At the heart of the efforts is the need to increase the numbers of medical students choosing primary care careers.

There are innumerable reasons medical students choose specialties other than primary care; probably as many reasons as there are medical students. Lifestyle, income, prestige, etc--all of these play a role. There has been a trend in medical students choosing the better-paid and better-lifestyle ROAD specialties (Radiology, Orthopedics, Anesthesia, Dermatology), while primary care specialties have struggled to attract high quality applicants.

There are many steps to addressing this issue. We need to make primary care more appealing to students, which will require addressing the costs of medical education, the payment structure of a health care system where procedural specialties are paid better than "intellectual" specialties, looking at concerns of physician burnout, etc.

Passing health care reform was a critical step. Now, we have to turn our sights to the next steps to make the promises real.

Non-partisan Assessment of Healthcare Reform

A week or so ago, I saw a Republican "assessment" of healthcare reform law. Simply reviewing the language makes it clear that you can't really expect an unbiased opinion.

I realize that similar claims could be made towards the Democrats summaries, though.

So, I submit a summary from the non-partisan Kaiser Family Foundation. This provides a thorough overview of the changes the law brings into effect.

So, I hope this further clarifies what is REALLY happening, and not what either side would like us to believe MIGHT happen.

What To Expect

With all the noise, hot air and nonsense over the last year, it is no surprise that folks might now know what the recently passed healthcare legislation actually includes. A couple of resources that might help: this one summarizes key points of the bill, and this one shows a timeline to implementation.

To give you a sense of what to expect in the next 6 months:
--Access to insurance for uninsured patients with pre-existing conditions.
--Small business tax credits.
--$250 rebates for seniors in the Medicare Part D donut hole (no drug coverage).
--Eliminating pre-existing condition restrictions for children.
--Prohibiting recissions (when insurance companies take back a policy you bought).
--Eliminating lifetime limits.
--Regulating use of annual limits on insurance.

Honestly, not a bad 6-9 months' work.

It Is Accomplished...

Last night, the House passed the reconciliation bill after the Senate's modifications. With this action, the legislative process for healthcare reform is complete. This bill will be forwarded to the President's desk for signature, and means that healthcare is now law. The House's fixes to the Senate bill include improving the affordability provisions for lower income families, and repealing some of the more egregious special deals put into the bill during Senate negotiations.

Prohibitions against health insurance companies denying care for children due to pre-existing conditions go into effect immediately. Health insurance reforms start to take meaningful effect in 6 months with increasing protections over the next 4 years.

This bill is far from what I might have hoped for. It essentially props up the private insurance market, although it does make the market less predatory towards individuals and more accountable for their actions. This law extends healthcare insurance to 32 million uninsured people once it takes full effect.

Most importantly, this bill addresses the issue of whether healthcare is a right or a privilege. As a nation, we have now moved forward and determined that it is a reasonable and appropriate goal for healthcare to be available for all. This law is an imperfect vehicle for bringing this to pass, but it has been accomplished just the same.

So--after more than a year of effort and a century of hope, the country to move forward.

Now, our work is to help make this bill life up to its intent and anticipated benefit.

And From The Senate Back To the House

Now that the healthcare reform bill has been passed by the House, the remaining issue is to address the reconciliation package. This package passed the Senate today and has to return to the House for the final vote because of some procedural changes brought about in the Senate. This is apparently expected tonight and, if passed, will bring to a close the legislative process regarding healthcare reform.

Healthcare Reform Passes The House

Tonight, the House passed the Senate's healthcare reform bill, and then passed the budget reconciliation bill. The Senate's bill, now having been passed by both chambers of Congress, moves to the President for signature into law while the reconciliation package moves back to the Senate for passage.

This is a big day--the first time in over 60 years that presidential and national efforts to expand healthcare coverage has passed out of the Congress. I truly and deeply believe that this legislation will make a substantial difference in peoples' lives. The expanded access to care and the reforms on insurance companies are critical steps.

Did I want more? Yes. Am I happy with the bill? Happy enough.

Every journey of 1,000 miles begins with a single step. This is the first significant milestone on that journey.